Neurosurgery
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Randomized Controlled Trial
High dose magnesium infusions are not associated with increased pressor requirements after carotid endarterectomy.
Although magnesium provides cerebral protection in animal stroke models, magnesium therapy has significant side effects in humans. Therefore, we sought to examine the incidence of alpha-agonist treated hypotension in our ongoing, prospective, randomized, double-blind, placebo-controlled Phase I/IIa dose escalation study of magnesium therapy in patients undergoing carotid endarterectomy. ⋯ There were no significant differences detected in the 1) percentage of patients requiring pressor support, 2) the duration of postoperative pressor support, or 3) the amount of phenylephrine support needed between controls and magnesium treated patients. The percentage of patients requiring pressure support depended on the minimum systolic blood pressure ordered after surgery.
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Historical Article
Il Fasciculo di Medicina of 1493: medical culture through the eyes of the artist.
THE FASCICULUS MEDICINA, printed in 1491, is considered the first illustrated medical book. The Latin essays and illustrations in this volume provide insight into the medical knowledge of Western Europe and, in the Italian edition published in 1493, glimpses into the medical culture of the late 15th century. ⋯ The artist of the 1493 Fasciculo witnessed a paradigm shift occurring. In four woodcuts, the artist captured four themes: the relevance of knowledge-based medicine, the emergence of laboratory medicine, the Hippocratic lessons of patient observation, and the emerging revolution in anatomy.
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Neurofibromatosis 1 (NF1) is a common autosomal dominant disease characterized by complex and multicellular neurofibroma tumors. Significant advances have been made in the research of the cellular, genetic, and molecular biology of NF1. The NF1 gene was identified by positional cloning. ⋯ The Schwann cell was discovered to be the cell of origin for neurofibromas, but understanding of a more complicated interplay of multiple cell types in tumorigenesis, specifically recruited heterogeneous cell types such as mast cells and fibroblasts, has important implications for surgical therapy of these tumors. This review summarizes the most recent NF1 and neurofibroma literature describing the pathogenesis and treatment of nerve sheath tumors. Understanding the biological underpinnings of tumorigenesis in NF1 has implications for future surgical and medical management of neurofibromas.
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Matrix detachable coils (MDC; Boston Scientific/Target, Fremont, CA) are platinum coils coated with a bioabsorbable polymeric material (polyglycolic-polylactic acid). In animal models, the introduction of polyglycolic-polylactic acid-coated coils into experimental aneurysms resulted in a cellular reaction which promoted stable intra-aneurysmal scar tissue formation. The current study was undertaken to assess the durability of aneurysm occlusion after embolization with MDC. ⋯ In the absence of Neuroform stent support, aneurysms embolized with the MDC system demonstrated a significant rate of recanalization. Many of the recanalizations were of sufficient size to warrant retreatment. The rates of recanalization observed in the present series were comparable to, or worse than, those reported for bare platinum coils.
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To assess the status quo of clinical management in patients with ruptured intracranial aneurysms in Germany. In addition to preferences in vascular treatment (i.e., surgical versus endovascular), the choice of diagnostics and treatment options in the pre- and postprocedural phase is emphasized. ⋯ In Germany, aneurysmal subarachnoid hemorrhage remains a disease in which standardization of clinical management is highest in preoperative diagnostics, intensive care unit monitoring, and postoperative treatment. With respect to currently published guidelines for subarachnoid hemorrhage treatment, compliance is moderate. Preferred treatment for anterior circulation aneurysms is predominantly surgical, whereas endovascular treatment options are preferentially used in aneurysms of the posterior circulation. This survey serves as a basis to analyze future developments in the management of subarachnoid hemorrhage more effectively and as an aid in finding a consensus in treatment both nationally and internationally.